Health Care in America: Where is the Socialist Solution? by Ajamu Baraka from CounterPunch

The introduction of the Republican legislation to “repeal and
replace” Obamacare is no more than latest scrimmage in the ongoing
one-sided war against the poor and working class. The “Affordable Care
Act” (ACA, better known as Obamacare) proved to be both unaffordable and
unable to provide comprehensive care for millions. Nevertheless, with
the ACA being one of the only tangible “victories” Democrats could claim
for an administration with a dismal record of noteworthy
accomplishments, neoliberal Democrats and the party’s liberal base led
by Bernie Sanders are now coalesced around the ACA and have vowed to
defend it to the bitter end.
Yet, camouflaged by the hot rhetoric of confrontation and the
diversionary struggle of the duopoly, the common agenda and objective
interests being protected in this healthcare battle are quite clear. No
matter what version of the healthcare bill passes or if the ACA remains
in place, it will be a win for the market-based, for-profit
beneficiaries of the U.S. system. As long as healthcare remains
privatized, the real winners of healthcare reform will continue to be
the insurance companies, hospital corporations and pharmaceutical and
medical device companies.
That commitment to the interests of the insurance/medical complex
ensures that the interests of healthcare consumers, the uninsured, the
elderly and the sick will continue to be sacrificed to maintain a
healthcare delivery system in which thousands suffer premature deaths
from inadequate preventative treatment, millions are unable to afford
coverage and millions who have private insurance fear using it because
of prohibitive co-pays and deductibles.
That is why during the current debate the insurance companies have
been largely silent. There is no need to engage in public debate because
having largely written the ACA they are again deeply involved in the
construction of the current legislation. Their interests will be
protected even if it means forcing Republicans to embrace policies that
are at odds with their professed philosophies – like including
government subsidies for low-income people to purchase insurance. In
fact, the only comments from insurance companies in this debate were
related to their supposed concern that the Senate bill might not provide
enough assistance to those who need help to pay for healthcare. They
want what is being called a “stabilization fund” to reduce the numbers
of people who might opt out of coverage because they can’t afford it.
The Senate bill provides those funds, but they are temporary and are
scheduled to end after 2019. Which means that people will be forced to
make an unpalatable decision after that – purchasing insurance with
higher out-of-pocket costs like $10,000 deductibles or electing to go
without insurance altogether. If history is a guide, many will opt out.
In fact, the Congressional Budget Office predicts that the current bill
will push 22 million people back into the ranks of the uninsured with
the potential loss of millions of customers and potential profits for
healthcare corporations.
But the companies have a plan should those funds prove inadequate to
hold substantial numbers in the system: Increase individual premiums by
at least 20 percent more than the double-digit increases already under consideration.Coming to the aid of the Insurance/Medical complex: Ted Cruz and the Consumer Freedom Amendment
Insurers need large numbers of healthy people on the rolls, as their
premiums help defray the cost of care for those who are sick. Because
insurance companies are for-profit operations they set rates based on
the risk pool in a market. With the potential loss of customers if the
government does not provide adequate long-term subsidies, middle-class
consumers who earn too much to qualify for temporary premium assistance
will bear the brunt of any premium increases.
The Cruz amendment to the legislation has a solution to the possible
increase in premiums and healthcare costs in general. The so-called “Consumer Freedom Amendment”
represents the typical extreme individualism and anti-social sentiments
of the right wing. It essentially advocates for reducing the burden on
healthy consumers paying into system to help cover higher-risk fellow
citizens.
The Washington Post’s analysis of the Cruz amendment suggests:

“Under Senator Cruz’s plan, insurers could sell cheaper,
stripped-down plans free of Obamacare coverage requirements like
essential health benefits or even a guarantee of coverage. These sparser
plans would appeal to the healthiest Americans, who would gladly
exchange fewer benefits for lower monthly premiums.
But insurers would also have to sell one ACA-compliant plan. The
sickest patients would flock to these more expansive and expensive
plans because they need more care and medications covered on a
day-to-day basis. As a result, premiums for people with expensive and
serious medical conditions like diabetes or cancer would
skyrocket because all those with such serious conditions would be pooled
together.”

And how would the elderly and people with pre-existing conditions pay
for the increased premiums that they would face under the current
Senate bill and Cruz’s amendment? “The $100 billion stabilization fund
for states could help cover costs for the resulting pricier coverage
for those with preexisting conditions under this amendment.”
In an ironic twist that both exposes the class interests of this
initiative and its hypocritical approach to the question of the role of
the government, Cruz’s amendment affirms that role in the form of
subsidies for the sickest citizens and calls for an expansion of
government resources to cover them.
The Cruz plan would segment the insurance market into healthier and
higher-risk segments. High risk individuals along with the already-sick
and the elderly would be pushed out of the market because those premiums
would soar even with state subsidies, since insurance companies would
still set premium rates to maximize profits.
Given the lose-lose options for consumers now being debated in
Congress, the only rational objective for the majority of the people in
the U.S. is to move toward the complete elimination of the for-profit
healthcare system.Socialization of Healthcare: The Only Solution
The ideological and political opposition to state-provided healthcare
is reflected in the ACA and the various repeal-and-replace scenarios.
Through mandates, coercion and the transfer of public funds to the
insurance industry, the ACA delivered millions of customers to the
private sector in what was probably the biggest insurance shams in the
history of private capital. And that gift to the insurance companies is
only one part of the story. The public monies transferred to the private
sector amounted to subsidies for healthcare providers, hospital chains,
group physician practices, drug companies and medical device companies
and labs as well.
The Republican alternatives to the ACA variably supplement the
corporate handouts with more taxpayer-funded giveaways. And once the
private sector gains access to billions of dollars provided by the
state, they and their elected water-carriers fiercely resist any efforts
to roll those subsidies back.
The subsidies coupled with the mergers and acquisitions of hospital
corporations and insurance providers over last few years and a general
trend toward consolidation of healthcare services in fewer and fewer
hands underscored the iron logic of centralization and concentration of
capital represented by the ACA and was a welcome development for the
biggest players in the healthcare sector. The movement toward a monopolization of the American health-care
market means that rather than the reduction in healthcare costs that is
supposed to be the result of repeal and replace, the public can instead
expect those costs to escalate.
Many on the left have called for a single-payer system similar to
those that work well (if not perfectly) in Britain, the Netherlands,
Finland and elsewhere in Europe. But even with an “improved Medicare for
all” single-payer system, costs will continue to increase in the U.S.
because they cannot be completely controlled when all of the linkages in
the healthcare system are still firmly in the hands of private capital.
The only way to control the cost of healthcare and provide universal
coverage is to eliminate for-profit, market-based healthcare. Take
insurance companies completely out of the mix and bring medical device
companies, the pharmaceuticals companies and hospitals chains under
public control.
The ideological implications of the Cruz amendment are that it
reflects a growing public perception both domestically and
internationally that healthcare should be viewed as a human right.
Putting people at the center instead of profit results in healthcare
systems that can realize healthcare as a human right. This is the lesson
of Cuba where the United Nations World Health Organization declared that Cuba’s health care system was an example for all countries of the world.
That is the socialist option, the only option that makes sense and
the one that eventually will prevail when the people are ready to fight
for it.Ajamu Baraka is the national organizer of the Black Alliance for
Peace and was the 2016 candidate for vice president on the Green Party
ticket. He is an editor and contributing columnist for the Black Agenda
Report and contributing columnist for Counterpunch magazine.

Ajamu Baraka is a human rights
activist, organizer and geo-political analyst. Baraka is an Associate
Fellow at the Institute for Policy Studies (IPS) in Washington, D.C. and
editor and contributing columnist for the Black Agenda Report. He is a
contributor to “Killing Trayvons: An Anthology of American Violence” (CounterPunch Books, 2014). He can be reached at www.AjamuBaraka.com